Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations

Brzezinski, Marek; Luisetti, Thomas; London, Martin J.

doi:10.1213/ane.0b013e3181bbd416

Cited by 354Vascular Procedures and ComplicationsCentral Venous Catheters and HemodialysisHemodynamic Monitoring and Therapy

Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations

Brzezinski, Marek, Luisetti, Thomas, London, Martin J.·2009·Anesthesia & Analgesia

DOI 10.1213/ane.0b013e3181bbd416

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Abstract

Consistent anatomic accessibility, ease of cannulation, and a low rate of complications have made the radial artery the preferred site for arterial cannulation. Radial artery catheterization is a relatively safe procedure with an incidence of permanent ischemic complications of 0.09%. Although its anatomy in the forearm and the hand is variable, adequate collateral flow in the event of radial artery thrombosis is present in most patients. Harvesting of the radial artery as a conduit for coronary artery bypass grafting, advances in plastic and reconstructive surgery of the hand, and its use as an entry site for cardiac catheterization has provided new insight into the collateral blood flow to the hand and the impact of radial arterial instrumentation. The Modified Allen's Test has been the most frequently used method to clinically assess adequacy of ulnar artery collateral flow despite the lack of evidence that it can predict ischemic complications in the setting of radial artery occlusion. Doppler ultrasound can be used to evaluate collateral hand perfusion in an effort to stratify risk of potential ischemic injury from cannulation. Limited research has demonstrated a beneficial effect of heparinized flush solutions on arterial catheter patency but only in patients with prolonged monitoring (>24 h). Conservative management may be equally as effective as surgical intervention in treating ischemic complications resulting from radial artery cannulation. Limited clinical experience with the ultrasound-guided arterial cannulation method suggests that this technique is associated with increased success of cannulation with fewer attempts. Whether use of the latter technique is associated with a decrease in complications has not yet been verified in prospective studies. Research is needed to assess the safety of using the ulnar artery as an alternative to radial artery cannulation because the proximity and attachments of the ulnar artery to the ulnar nerve may potentially expose it to a higher risk of injury.

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Signals associated with crying have distinctive frequencies typically between 400 and 500 Hz, with strong harmonics, well separated from cardiac activity (1-50 Hz), muscle tremors (<20 Hz), and operations in care such as patting, rubbing or stroking.
“The signals associated with crying have distinctive frequencies (typically between 400 and 500 Hz, with strong harmonics), well separated from other physiological effects such as cardiac activity (1 – 50 Hz) and muscle tremors (< 20 Hz)43–45 or from various operations in care such as patting, rubbing or stroking (see Supplementary Figs. 24a–c).”
From Skin-interfaced biosensors for advanced wireless physiological monitoring in neonatal and pediatric intensive-care units (2020) · cites this paper as [44]

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Skin-interfaced biosensors for advanced wireless physiological monitoring in neonatal and pediatric intensive-care units
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Ultrasonography-guided radial artery catheterization is superior compared with the traditional palpation technique
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Modified Short-Axis Out-of-Plane Ultrasound Versus Conventional Long-Axis In-Plane Ultrasound to Guide Radial Artery Cannulation
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Imputation of the continuous arterial line blood pressure waveform from non-invasive measurements using deep learning
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Guidelines for Performing Ultrasound-Guided Vascular Cannulation: Recommendations of the American Society of Echocardiography
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Complications Related to Radial Artery Occlusion, Radial Artery Harvest, and Arterial Lines
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Short-axis/out-of-plane or long-axis/in-plane ultrasound-guided arterial cannulation in children
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The ACRA Anatomy Study (Assessment of Disability After Coronary Procedures Using Radial Access)
van Leeuwen, M. A. H., Hollander, M. R., van der Heijden, D. J., van de Ven, P. M., Opmeer, K. H. M., Taverne, Y. J. H. J., Ritt, M. J. P. F., Kiemeneij, F., Mieghem, N. M. V., & van Royen, N. (2017) · Circulation Cardiovascular Interventions · doi:10.1161/circinterventions.117.005753 · Cited by 59 · see citing works
AIUM Practice Guideline for the Use of Ultrasound to Guide Vascular Access Procedures
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AIUM Practice Parameter for the Use of Ultrasound to Guide Vascular Access Procedures
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Noninvasive In-Situ Measurement of Blood Lactate Using Microwave Sensors
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Ultrasound guidance versus direct palpation for radial artery catheterization by expert operators: a randomized trial among Canadian cardiac anesthesiologists
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Radial artery diameter: a comprehensive systematic review of anatomy
Wahood, W., Ghozy, S. A., Al-Abdulghani, A., & Kallmes, D. F. (2022) · Journal of NeuroInterventional Surgery · doi:10.1136/neurintsurg-2021-018534 · Cited by 53 · see citing works
The Accuracy of the CNAP®Device Compared with Invasive Radial Artery Measurements for Providing Continuous Noninvasive Arterial Blood Pressure Readings at a Medical Intensive Care Unit
Smolle, K., Schmid, M., Prettenthaler, H., & Weger, C. (2015) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000000965 · Cited by 53 · see citing works
The role of ultrasound guidance for vascular access
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Arterial line in prehospital emergency settings – A feasibility study in four physician-staffed emergency medical systems
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Brachial Arterial Pressure Monitoring during Cardiac Surgery Rarely Causes Complications
Singh, A., Bahadorani, B., Wakefield, B. J., Makarova, N., Kumar, P. A., Tong, M. Z.-Y., Sessler, D. I., & Duncan, A. E. (2017) · Anesthesiology · doi:10.1097/aln.0000000000001626 · Cited by 49 · see citing works
Clinical performance of a machine-learning algorithm to predict intra-operative hypotension with noninvasive arterial pressure waveforms
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Validation of non-invasive arterial pressure monitoring during carotid endarterectomy
Heusdens, J. F., Lof, S., Pennekamp, C. W. A., Specken-Welleweerd, J. C., de Borst, G. J., van Klei, W. A., van Wolfswinkel, L., & Immink, R. V. (2016) · British Journal of Anaesthesia · doi:10.1093/bja/aew268 · Cited by 47 · see citing works
Impact of non invasive and beat-to-beat arterial pressure monitoring on intraoperative hemodynamic management
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Critical hand ischaemia after transradial cardiac catheterisation: an uncommon complication of a common procedure
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Open surgical management of complications from indwelling radial artery catheters
Garg, K., Howell, B. S., Saltzberg, S. S., Berland, T. L., Mussa, F. F., Maldonado, T. S., & Rockman, C. R. (2013) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2013.05.011 · Cited by 41 · see citing works
Comparison of short-axis out-of-plane versus long-axis in-plane ultrasound-guided radial arterial cannulation in adult patients: a randomized controlled trial
Sethi, S., Maitra, S., Saini, V., Samra, T., & Malhotra, S. K. (2016) · Journal of Anesthesia · doi:10.1007/s00540-016-2270-6 · Cited by 41 · see citing works
Radial Artery Access for Percutaneous Cardiovascular Interventions: Contemporary Insights and Novel Approaches
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Contactless and continuous blood pressure measurement according to caPTT obtained from millimeter wave radar
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The Effect of Transradial Coronary Catheterization on Upper Limb Function
van Leeuwen, M. A. H., Mieghem, N. M. V., Lenzen, M. J., Selles, R. W., Hoefkens, M. F., Zijlstra, F., & van Royen, N. (2015) · JACC: Cardiovascular Interventions · doi:10.1016/j.jcin.2014.10.025 · Cited by 38 · see citing works
Heparin versus normal saline for patency of arterial lines
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Blood flow dynamics in patients with hemodialysis access-induced hand ischemia
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Reevaluation of the utilization of arterial blood gas analysis in the Intensive Care Unit: Effects on patient safety and patient outcome
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Invasive monitoring of blood pressure: a radiant future for brachial artery as an alternative to radial artery catheterisation?
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Radial artery access site complications during cardiac procedures, clinical implications and potential solutions: The role of nitric oxide
Coghill, E. M., Johnson, T., Morris, R. E., Megson, I. L., & Leslie, S. J. (2019) · World Journal of Cardiology · doi:10.4330/wjc.v12.i1.26 · Cited by 37 · see citing works
Revealing the impact of local access-site complications and upper extremity dysfunction post transradial percutaneous coronary procedures
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Feasibility of ulnar artery for cardiac catheterization: AJ mer UL nar AR tery ( AJULAR ) catheterization study
Gokhroo, R. K., Bisht, D. S., Padmanabhan, D., Gupta, S., Kishor, K., & Ranwa, B. L. (2015) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.25806 · Cited by 35 · see citing works
Vascular Insufficiency of the Upper Extremity
Higgins, J. P., & McClinton, M. A. (2010) · The Journal Of Hand Surgery · doi:10.1016/j.jhsa.2010.06.011 · Cited by 34 · see citing works
Evaluation of radial and ulnar blood flow after radial artery cannulation with 20‐ and 22‐gauge cannulae using duplex Doppler ultrasound
Kim, S. Y., Lee, J. S., Kim, W. O., Sun, J. M., Kwon, M., & Kil, H. K. (2012) · Anaesthesia · doi:10.1111/j.1365-2044.2012.07235.x · Cited by 33 · see citing works
Can VBG analysis replace ABG analysis in emergency care?
Kelly, A. (2014) · Emergency Medicine Journal · doi:10.1136/emermed-2014-204326 · Cited by 33 · see citing works
Ultrasonic Technology Improves Radial Artery Puncture and Cannulation in Intensive Care Unit (ICU) Shock Patients
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Radial artery cannulation in intensive care unit patients: Does distance from wrist joint increase catheter durability and functionality?
Imbrìaco, G., Monesi, A., Giugni, A., & Cilloni, N. (2020) · The Journal of Vascular Access · doi:10.1177/1129729820953020 · Cited by 32 · see citing works
Evaluation of anatomy and variations of superficial palmar arch and upper extremity arteries with CT angiography
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Complications of Transradial Catheterization and Cannulation
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An anatomical investigation of the superficial and deep palmar arches
Singh, S. D., Lazarus, L., Gama, B. Z. D., & Satyapal, K. S. (2016) · Folia Morphologica · doi:10.5603/fm.a2016.0050 · Cited by 29 · see citing works
Development of continuous cuffless blood pressure prediction platform using enhanced 1-D SENet–LSTM
Zhang, G., Choi, D., & Jung, J. (2023) · Expert Systems with Applications · doi:10.1016/j.eswa.2023.122812 · Cited by 28 · see citing works
Rationale and design of the ARCUS: Effects of trAnsRadial perCUtaneouS coronary intervention on upper extremity function
Zwaan, E. M., Ijsselmuiden, A. J. J., van Rosmalen, J., van Geuns, R., Amoroso, G., Moerman, E., Ritt, M. J. P. F., Schreuders, T. A. R., Kofflard, M. J. M., & Holtzer, C. A. J. (2016) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.26525 · Cited by 28 · see citing works
Vascular Complications Following Transradial and Transulnar Coronary Angiography in 1600 Consecutive Patients
Hahalis, G. N., Tsigkas, G., Kakkos, S. K., Panagopoulos, A., Tsota, I., Davlouros, P. A., Xanthopoulou, I., Koniari, I. C., Grapsas, N., Christodoulou, I., et al. (2015) · Angiology · doi:10.1177/0003319715592095 · Cited by 27 · see citing works
Ultrasound-guided dynamic needle tip positioning technique for radial artery cannulation in elderly patients: A prospective randomized controlled study
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Authors: Brzezinski, M., Luisetti, T., & London, M. J.
Affiliations: Sierra Nevada Memorial Hospital Foundation (US)
San Francisco VA Medical Center (US)
Corresponding author: London, Martin J.
ORCID: London, Martin J.
Venue: Anesthesia & Analgesia
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2009-12
Volume: 109
Issue: 6
Pages: 1763-1781
ISSN: 0003-2999 (ISSN-L)
DOI: 10.1213/ane.0b013e3181bbd416
OpenAlex: W2088171863
Cited by: 354
References: 276
Citations by year: 2026: 11 · 2025: 22 · 2024: 25 · 2023: 25 · 2022: 24 · 2021: 23 · 2020: 22 · 2019: 18 · 2018: 15 · 2017: 19 · 2016: 19 · 2015: 27 · 2014: 34 · 2013: 28 · 2012: 22
FWCI: 2.08
Type: journal article
Language: en
Open access: closed
Locations: Anesthesia & Analgesia (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vascular Procedures and Complications
Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
Keywords: radial artery cannulation, arterial catheterization, ischemic complications, ulnar artery, Doppler ultrasound, coronary artery bypass grafting, hand reconstruction, cardiac catheterization, ultrasound-guided cannulation, ulnar nerve injury
MeSH terms: Anticoagulants, Coronary Artery Bypass, Catheterization, Peripheral, Collateral Circulation, Heparin, Humans, Ischemia, Regional Blood Flow, Thrombosis, Radial Artery, Ulnar Artery, Risk Assessment, Tissue and Organ Harvesting, Upper Extremity, Atherosclerosis

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Radial Artery Cannulation: A Comprehensive Review of Recent Anatomic and Physiologic Investigations

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